TRAP-coated bone grafts and prostheses

ABSTRACT

A composition or device suitable for orthopedic or dental implantation to bone, characterized by tartrate-resistant acid phosphatase (TRAP) adsorbed to a porous hydroxyapatite substratum.

[0001] This application claims the benefit of U.S. ProvisionalApplication No. 60/044,033, filed Apr. 22, 1997.

[0002] This invention was made with government support under grant AR42657 awarded by the National Institutes of Health. The government hascertain rights in the invention.

FIELD OF THE INVENTION

[0003] This invention is predicated upon the discovery thattartrate-resistant acid phosphatase (TRAP) is a potent differentiatingfactor for osteoclasts. The invention provides, in the presently claimedembodiment, TRAP-coated bone grafts and implantable permanent orthopedicand dental prostheses.

BACKGROUND OF THE INVENTION

[0004] TRAP, also known as uteroferrin (12; see the appended Citations),purple acid phosphatase (13), or type 5 acid phosphatase (14-16), is aniron-containing, cationic glycoprotein with a molecular weight of about35 kDa. A variety of organs including bone, spleen, lung, placenta, thepregnant pig uterus and certain leukemic cells express this enzyme(12-17). TRAP enzyme activity is detected in blood and a high enzymelevel reflects active bone remodeling (18,19). In bone, the enzyme ishighly expressed by multinuclear osteoclasts and mononuclear cellsthought to be osteoclasts or osteoclast precursors (15). The high levelof expression by osteoclasts and TRAP concentration in cytoplasmicvacuoles, extracellular channels, ruffled borders and at the cell-boneinterface have implicated the enzyme in bone matrix degradation (20).The function of TRAP, however, is still unknown. A blocking antibody toporcine uteroferrin markedly inhibited both the enzyme activity and boneresorption by osteoclasts in vitro (21). Several reports point to a rolefor TRAP in bone remodeling. Knock-out mice lacking TRAP, generated bythe homologous recombination technique, showed abnormal endochondralossification of bones and an unusual form of mild osteopetrosis (22). Anumber of studies have shown that M-CSF plays a critical role in bothmacrophage and osteoclast maturation and function (3).

[0005] Osteoclasts, the cells that resorb bone, are essential for normalskeletal growth and remodeling. They are derived from hematopoieticprogenitor/stem cells of the granulocyte/macrophage lineage, but theexact point of their divergence is controversial (1,2). While recentstudies have revealed several factors involved in cell-to-cellinteractions in development of osteoclast function (3,4), regulation ofosteoclast progenitor differentiation and recruitment to a bone surfacefor resorption is still poorly understood. Better understanding of themolecular mechanisms of osteoclast differentiation and recruitment couldlead to novel diagnostics and therapeutics for use in the prevention andmanagement of osteoporosis, a common disease that results from a netimbalance between bone resorption and bone formation in the adultskeleton. This imbalance can widen when resorption accelerates aftermenopause associated with an increase in osteoclast numbers andresorptive activity. It is also known that certain carcinomas are proneto metastasize to bone and/or can release factors locally orsystemically that promote osteolysis (bone resorption). The molecularand cellular bases of such tumor properties are not fully understood.

SUMMARY OF THE INVENTION

[0006] The invention provides, in the presently claimed embodiment, acomposition or device suitable for orthopedic or dental implantation tobone, characterized by tartrate-resistant acid phosphatase (TRAP)adsorbed to a porous hydroxyapatite substratum. Such implants includeautologous bone grafts, cadaveric bone allografts,hydroxyapatite-containing bone cements, prosthetic devices such asartificial joints and teeth having hydroxyapatite-coated bone attachmentsurfaces, and orthopedic attachment devices such as staples and plateshaving hydroxyapatite-coated bone contacting surfaces.

[0007] Upon implantation, the TRAP coating serves to recruit or attractosteoclast progenitor cells from the bone marrow or bloodstream to thebone implant or hydroxyapatite surface of the prosthetic or attachmentdevice. The recruited osteoclast population etches the bone mineral orhydroxyapatite surface of the implant and thereby provides the naturalsignals to recruit osteoblasts to lay down new bone that will abut andintegrate with the graft or prosthetic surface mimicking the naturalprocess of bone deposition on an osteoclast resorbed bone surface. TheTRAP-induced stimulation of osteoclast recruitment results inosteointegration and enhanced bonding of the graft or prosthesis to thepatient's bone. This reduces recovery time from the operation andlengthens the life of implants by reducing their well-documentedtendency to loosen over several years. Bone grafts also are integratedmore effectively mechanically and biologically into living bone at theimplant site.

BRIEF DESCRIPTION OF THE DRAWINGS

[0008] The foregoing aspects and many of the attendant advantages ofthis invention will become more readily appreciated as the same becomesbetter understood by reference to the following detailed description,when taken in conjunction with the accompanying drawings, wherein:

[0009]FIG. 1 shows results of protein purification of initial CESJmedium by heparin-sepharose chromatography, as described in theExamples. In this graphical data presentation, both biological activity(shaded bars) in terms of TRAP-positive cells per well, and proteincontent (dotted line) measured by absorbance at 280 nm, are plotted onthe ordinate; and eluted column fractions are shown on the abscissa;

[0010]FIG. 2 shows further purification of TRAP-positive activity on ahydroxyapatite column. The data are plotted on the ordinate and abscissahere as in FIG. 1; and

[0011]FIG. 3 shows final isolation of TRAP by size-exclusion columnHPLC. Here, both biological activity (shaded bars) in terms ofTRAP-positive cells per well, and protein content (solid trace) measuredby absorbance at 220 nm, are plotted on ordinate of the upper graph(FIG. 3A), and TRAP enzyme activity, measured by p-nitro phenylphosphate cleavage, is plotted on the ordinate of the lower graph (FIG.3B) in terms of mUnits of TRAP/ml (dotted line); elution volume (ml) isshown on the common abscissa.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

[0012] Here we describe the isolation and characterization of the uniquefactor primarily responsible for the potent osteoclast-recruitingproperties of a murine mammary carcinoma cell line, CESJ. The biologicalactivity was isolated by sequential heparin-affinity, hydroxyapatite andmolecular-sieve chromatography. The molecule unexpectedly proved to betartrate-resistant acid phosphatase (TRAP) by N-terminal sequence andenzyme activity analysis. Recombinant TRAP was prepared and shown topromote osteoclast colony formation in vitro from mouse marrow stemcells, similar to the observations for the molecule isolated from CESJtumor cell-conditioned medium. We conclude that TRAP, perhaps throughits enzyme activity as a phosphatase or generator of oxygen-derived freeradicals, acts as a potent differentiating factor for osteoclasts.

[0013] We propose a role for TRAP in normal bone biology in recruitingosteoclasts to particular bone surfaces targeted for resorption and alsoin continuing the local recruitment of new osteoclasts to active sitesof resorption by existing osteoclasts. Previous reports on anunexplained association of TRAP with osteocytes in woven bone, in thetransient medullary bone of egg-laying birds and in the matrix ofregions of bone and calcified cartilage destined for resorption areconsistent with a role as an osteoclast recruiting agent. Medullary boneis laid down within the long bone shafts of egg-laying birds as a sourceof rapidly available calcium for eggshell formation (Roach, H. I. (1997)J. Bone Miner. Res. 12, 795-805). This bone is formed and rapidlyresorbed in phase with the egg-laying cycle. Male birds (quail)administered estrogen will also lay down medullary bone. The matrix ofmedullary bone stains positively for TRAP unlike permanent bone(Yamamoto, T. and Nagai, H. (1992) J. Bone Miner. Res. 7, 1267-1273 and(1994) 9, 1153-1157). It was concluded that osteoblasts are involved inthis matrix accumulation of TRAP even though the cells themselves do notstain for TRAP. These observations are consistent with the presentdiscovery that TRAP is a potent differentiating factor for osteoclastsand with the proposed role for TRAP as a local recruiting agent fortargeting osteoclasts to resorb a particular region of bone tissue. Itis predicted that osteocytes and osteoblasts in certain local regions ofbone can target the tissue for resorption and remodeling by expressingTRAP which becomes bound to the hydroxyapatite mineral phase of thematrix. The observed binding affinity of TRAP to hydroxyapatite mighthave biological significance in this proposed role of recruitingosteoclasts locally to mineralized tissue regions targeted forresorption.

[0014] The present findings reveal that TRAP has a direct role as alocal factor in the recruitment of osteoclasts from hemopoietic stemcells. Thus, in normal bone physiology, the TRAP secreted by osteoclastsmay act locally to recruit additional osteoclasts to differentiate fromstem cells in the marrow or from circulating progenitor cells on themacrophage/osteoclast lineage. This signaling action may be mediated bythe TRAP molecule acting as a ligand through a ligand/cell surfacereceptor mechanism or more likely by a consequence of TRAP catalyticactivity, either phosphatase activity or generation of oxygen radicalsor other reactive oxygen species. It was previously reported thatoxygen-derived free radicals can stimulate osteoclast generation in bonecultures, but TRAP was not implicated as the source.

[0015] The present findings have practical implications for orthopedic,diagnostic, and therapeutic procedures.

Improved Bone Grafts and Prostheses

[0016] The observed binding affinity or adsorption of TRAP tohydroxyapatite has important implications for providing improved boneand dental implants. Such implants include autologous bone grafts,cadaveric bone allografts, hydroxyapatite-containing bone cements,prosthetic devices such as artificial joints and teeth havinghydroxyapatite-coated bone attachment surfaces, and orthopedicattachment devices such as staples and plates havinghydroxyapatite-coated bone contacting surfaces. Pursuant to theinvention, enzymically active TRAP, e.g., from a recombinant source, isadsorbed to the hydroxyapatite component of the bone graft, bone cement,or device prior to implantation. In the case of autologous bone implantsor banked bone tissue, the bone graft can simply be dipped in a sterilesolution of TRAP in the operating theater prior to implantation. Anallograft of bone implanted at a surgical site where eventual completereplacement by host bone is desired can be impregnated rather than justsurface coated with TRAP. Hydroxyapatite-coated prosthetic devices canbe manufactured with a predetermined penetration of adsorbed TRAP, e.g.,on the order of about 10 microns, as measured for quality control bymethods used histochemically to assess TRAP enzyme activity distributionin mineralized tissue sections. In any case the TRAP binds to the bonemineral (i.e., hydroxyapatite) or to the hydroxyapatite surface of theimplant. Either enzymically active TRAP or a latent form that can beactivated in the body by proteolysis or other means can be used.

[0017] Upon implantation, the TRAP coating serves to recruit or attractosteoclast progenitor cells from the bone marrow or bloodstream to thebone implant or hydroxyapatite surface of the prosthetic or attachmentdevice. The recruited osteoclast population etches the bone mineral orhydroxyapatite surface of the implant and thereby provides the naturalsignals to recruit osteoblasts to lay down new bone that will abut andintegrate with the graft or prosthetic surface mimicking the naturalprocess of bone deposition on an osteoclast resorbed bone surface. TheTRAP-induced stimulation of osteoclast recruitment results inosteointegration and enhanced bonding of the graft or prosthesis to thepatient's bone. This reduces recovery time from the operation andlengthens the life of implants by reducing their well-documentedtendency to loosen over several years. Bone grafts also are integratedmore effectively mechanically and biologically into living bone at theimplant site.

[0018] Hydroxyapatite (also known as hydroxylapatite, calcium hydroxidephosphate, calcium triphosphate, and tricalcium phosphate), Ca₅(PO₄)₃OH,is the major mineral component of bone. As used herein, the term“hydroxyapatite” is meant to also encompass derivative calcium phosphatecompounds used in orthopedic and dental implants. A wide range of suchderivative compounds have been constituted from reactions between, e.g.,calcium oxide and phosphorous pentoxide. The resulting ceramics can bemade in at least eight crystalline forms, with various microstructuresand densities, and may contain other elements as well. (Campbell'sOperative Orthopaedics, Eighth Edition, A. H. Crenshaw (Ed.), Mosby YearBook, p. 382, 1992.) (See, e.g., U.S. Pat. No. 5,171,326 entitled“Calcium phosphate ceramics for bone tissue calcification enhancement”and U.S. Pat. No. 4,097,935 entitled “Hydroxylapatite ceramic.”) Poroushydroxyapatite for medical uses has also been formed by conversion ofPorites goniopora coral exoskeleton (coralline hydroxyapatite) (ProOsteon, Interpore International). Formulations are available forinjection and in situ setting of bone fractures (e.g., SRS cancellousbone cement, Norian Corporation) to provide mechanical strength andallow for remodeling to occur with time by natural cellular mechanisms.

[0019] Porous coatings of hydroxyapatite are conventionally applied byplasma-spraying techniques to bone contacting surfaces of permanent boneprostheses. (See, e.g., U.S. Pat. No. 5,397,362 entitled “Implantprosthesis and method for producing same” and U.S. Pat. No. 5,279,831entitled “Hydroxyapatite prosthesis coatings.”) For example, in anartificial hip prosthesis, the titanium alloy stem that will be insertedinto a patient's femur is coated with an approximately 50 micron thicklayer of hydroxyapatite ceramic. The porous hydroxyapatite surfacepromotes bone growth and integration between the implant and the host,alleviating the need for acrylic bone cement, and providing enhancedmechanical force transfer. Improved functional outcome of the totaljoint replacement results. (For example, see U.S. Pat. No. 5,730,598,entitled “Prosthetic implants coated with hydroxylapatite and processfor treating prosthetic implants plasma-sprayed with hydroxylapatite.”)

[0020] In summary, this aspect of the invention provides a compositionor device suitable for orthopedic or dental implantation to bone,characterized by tartrate-resistant acid phosphatase (TRAP) adsorbed toa porous hydroxyapatite substratum.

[0021] The subject compositions include bone graft compositions, whereinthe hydroxyapatite substratum is selected from among autologous bone,cadaveric allograft bone, coralline hydroxyapatite, and synthetichydroxyapatite blocks. In one embodiment, the TRAP is adsorbedthroughout the porous hydroxyapatite substratum. In a preferredembodiment, the TRAP is adsorbed to only the outer surface of the poroushydroxyapatite substratum.

[0022] The subject compositions also include bone cement compositions,wherein tartrate-resistant acid phosphatase (TRAP) is adsorbed to aparticulate hydroxyapatite substratum (e.g., IRC bone cement, Universityof London Interdisciplinary Research Centre in Biomedical Materials)which may be admixed in a self-curing acrylic polymer such aspolymethylmethacrylate (PMMA). Alternatively, calcium phosphate cementswhich self-harden to hydroxyapatite (e.g., U.S. Pat. No. 5,525,148) canbe formulated with TRAP pursuant to this invention.

[0023] The subject devices include prosthetic devices having at leastone outer bone attachment surface on which tartrate-resistant acidphosphatase (TRAP) is adsorbed to a hydroxyapatite substratum.Preferably the TRAP is adsorbed to the outer approximately 10 microns ofthe hydroxyapatite substratum, in which case this outer layer can bespray-coated with relatively absorbable low molecular weighthydroxyapatite, prior to adsorption of the TRAP. Representativeprosthetic devices for this purpose include artificial joints andartificial teeth.

[0024] The subject devices also include orthopedic attachment deviceshaving at least one bone contacting surface on which tartrate-resistantacid phosphatase (TRAP) is adsorbed to a porous hydroxyapatitesubstratum. Representative attachment devices for this purpose includescrews, staples, pins, bolts, and plates. For example, the bonecontacting undersurface of a stainless steel plate is plasmaspray-coated with hydroxyapatite, to which TRAP is subsequentlyadsorbed. DIAGNOSTICS

[0025] In the management of tumors and malignancies that are potentiallymetastatic to bone and/or osteolytic, screening for TRAP expression bythe malignant cells may be an important diagnostic tool. The presentfindings derived from a mouse mammary carcinoma are predictive that asubset of human breast cancers and perhaps other tumors also expressTRAP. The revealed osteoclast-differentiating activity of TRAP may,therefore, explain the overt osteolytic effects of many cancers, both asprimary tumors and on metastasis to bone.

[0026] One aspect of the invention accordingly involves using TRAP as adiagnostic marker for identifying osteolysis-promoting tumors at biopsy.The biopsied tissues or cells can be screened directly for TRAPexpression, e.g., using available polymerase chain reaction (PCR) or insitu hybridization techniques. Direct histochemical staining methods forTRAP enzyme activity may not be reliable alone. The CESJ cell linesdescribed here secrete abundant TRAP, but the cells do not retain andtherefore stain for TRAP in the way that osteoclasts do.

[0027] Reverse transcription-polymerase chain reaction techniques, thatcan be applied to appropriate TRAP oligomer primers and total or poly A+selected messenger RNA isolated from tissue samples, have been described(Veres, G., et al., 1987, Science 237:415-417; Kawasaki, E. S. 1990.Amplification of RNA. In: Innis, M. A. et al. (Eds.) PCR Protocols, AGuide to Methods and Applications. Academic Press Inc., San DiegoCalif., pp. 21-27). Aberrant expression of TRAP in pathological biopsytissue samples can also be examined by RT-PCR or by in situhybridization techniques on fixed tissue sections with antisense TRAPprobes (Hafen, E. et al., 1983. EMBO J 2:617-623; Zeller, R. and Rogers,M. 1989. In situ hybridization to cellular RNA. In: Ausubel, F. M. etal. (Eds.), Current Protocols in Molecular Biology. John Wiley and Sons,New York, pp. 14.3.1-14.3.14).

[0028] By determining that the cancer cells are expressing TRAP, theattending physician can prescribe appropriate treatment, such as abisphosphonate to prevent osteolysis and metastatic tumor growth in boneand in combination with anti-cancer chemotherapy.

[0029] It is also contemplated that TRAP produced by mammary carcinomasand other tumors may have distinguishing molecular features fromosteoclast TRAP, i.e. due to novel splicing variant(s) orpost-translational chemistry. This aspect of the invention accordinglyprovides a serum or body fluid diagnostic for potentially metastaticand/or osteolytic tumors. Conventional immunoassay techniques can beused to detect such tumor-associated TRAP molecules in a body fluidsample, using an antibody raised against the tumor-associated TRAPmolecules and/or screened to detect the tumor-associated TRAP moleculesbut not osteoclast-associated TRAP molecules.

Therapy

[0030] The present findings also suggest new therapeutic approaches tothe management of disorders of accelerated bone turnover and unbalancedbone resorption/formation.

[0031] The accelerated loss of bone after menopause in women is causedby an increased recruitment of osteoclasts and excessive boneresorption. By selectively targeting a recruitment mechanism ofosteoclasts for inhibition, this process can be slowed, stopped orreversed depending on the accompanying rate of bone formation.

[0032] Thus, selective inhibitor molecules of TRAP activity can serve asnovel anti-resorptive agents. One of the modes of action ofbisphosphonates at the molecular level as a treatment for osteoporosismay be in inhibiting TRAP activity. TRAP cleaves inorganic pyrophosphateas a substrate, so bisphosphonates may inhibit this action anddown-regulate signaling of osteoclast recruitment (for example, ifgeneration of oxygen-derived free radicals during pyrophosphate cleavagewas the local signal). Selective inhibitors of TRAP can therefore beidentified, as new agents for osteoporosis treatment and prevention, forexample by high-throughput screening using recombinant TRAP to identifycandidate molecules. Microwell assays for TRAP phosphatase orpyrophosphatase activity can be based for example on colored chromogengeneration (e.g., p-nitrophenyl phosphate cleavage) and used to screenfor selective inhibitors. Alternatively, oxygen radical generatingactivity of TRAP can be screened using luminol as the substrate in thepresence of hydrogen peroxide and measuring chemiluminescenceproduction. Histological methods at the light microscope level can alsobe used to screen for agents that inhibit TRAP enzyme activity(Fukushima, O., Bekker, P. J. and Gay, C. V. (1991) Amer. J. Anat.191:228-236). Such approaches may be adapted to recombinant TRAP spottedor otherwise adsorbed on thin layers of hydroxyapatite for screening ofactivity and inhibition microscopically. In particular, small moleculeinhibitors that do not become incorporated into the fabric of bonemineral can be identified as desirable alternatives to bisphosphonates.Such compounds can be sought by standard approaches in medicinalchemistry with reference to knowledge of the properties of knowninhibitors of TRAP, which include molybdate, tungstate, arsenate,fluoride, phosphate and dithionite ions (Allen et al. (1989) J. BoneMiner. Res. 4:47-55). Other candidates include vitamin E analogs andother compounds that are known to inhibit oxygen-derived radicalgeneration or scavenge reactive oxygen species. Compounds that haveminimal toxicity yet selectivity for the TRAP activity that promotesosteoclast differentiation are particularly desirable. A secondaryscreen seeking efficacy in blocking osteoclast recruitment can be basedon microwell cultures of bone marrow or spleen cells or other sources ofosteoclast progenitors, and TRAP (e.g., a recombinant preparation)adsorbed on a suitable solid-phase surface (e.g., thin layer ofhydroxyapatite coated on an inert substratum or particles of bone ordentin). Inhibition of the attachment of differentiated osteoclasts asobserved microscopically can be used as the outcome measure. Families ofcompounds can be rapidly screened in this way for a functional outcomein vitro. Compounds that are adsorbed on the bone mineral surface, forexample through an incorporated bisphosphonate group that will notdirectly block osteoclast resorbing activity, but down-regulateosteoclast recruitment to the surface, are desirable. Such TRAPinhibitory agents when administered to patients turn down theosteoclast-recruiting activity of TRAP, leading to a beneficial effectin bone mass.

[0033] As noted above, TRAP enzyme activity is inhibited by molybdate,tungstate, arsenate, fluoride, phosphate and dithionite. The potentbone-forming properties of fluoride have not been fully explained. Giventhe present findings, local inhibition of osteoclast recruitment byinhibition of TRAP activity is one potential contributing mechanism,thereby imbalancing the coupled resorption and formation activities atremodeling sites in favor of formation. The mechanism of action of thevarious bisphosphonates in blocking osteoclastic resorption is not fullyunderstood. Blocking of terminal differentiation of osteoclastprogenitors is one observed action. Though bisphosphonates areconsidered to be relatively poor inhibitors of TRAP activity (Allen etal., (1989) J. Bone Miner. Res. 4:47-55), no extensive studies appear tohave been carried out comparing the inhibitory action of the variousbisphosphonates now approved or undergoing trial for clinical use. Ifthe persistent gain in bone produced clinically by alendronate and otherbisphosphonates in part reflects an inhibition of the TRAP activityresponsible for recruiting osteoclast teams for resorption, yetpermitting formation to exceed resorption at remodeling sites, then anadditional therapeutic strategy is contemplated. Agents that stimulateor emulate TRAP activity could be given to activate resorption followedby a bisphosphonate to block resorption and build bone at the activationsites. Such cyclic, combination therapy could be used as a treatment formaximizing the therapeutic benefits of bisphosphonate therapy. Compoundshaving desired therapeutic properties could be screened usingrecombinant TRAP and appropriate culture and assay systems in vitro.

[0034] In this embodiment, TRAP or a TRAP emulator molecule (e.g., abinuclear iron-containing small molecule) is administered as an agent torecruit osteoclast activity followed by administration of ananti-resorptive agent to promote a net imbalance in remodeling in favorof enhanced bone formation. Here the goal is to activate as many bonesurfaces as possible by adsorbing TRAP to recruit osteoclast attachmentto them, then shut down the process after a short period (several days)by an inhibitor of osteoclasts before a significant amount of bone islost. Maximal recruitment of osteoblasts to build new bone will thenoccur. Representative anti-resorptive agents include bisphosphonates,estrogen and estrogen mimics, and calcitonins. Such a strategy has beenproposed and referred to as “ADFR” (for Activate, Depress, Free andRepeat), but using other agents to recruit the resorption phase of thebone remodeling cycle (Frost, H. M., Clin. Orthop. 143:227-244, 1979;Frost, H. M., Calcif. Tissue Intern. 36:349-353, 1984). The principle isto cycle the therapeutic regimen and so maximize the growth of new bone.In this way, bone mass may be built back, for example, to treat advancedosteopenia or prevent osteoporosis later in life for individuals (forexample, post-menopausal women) who already show low bone mass or otherrisk factors for osteoporosis. The advantage of TRAP in this approach ishigh specificity in recruiting osteoclasts.

[0035] Recombinant TRAP might be administered to do this, but smallermolecules that emulate TRAP osteoclast-recruiting activity (e.g.,oxygen-derived free radical generation) can also be designed to attachto mineral surfaces of bone (e.g., using a bisphosphonate that has weakor no osteoclast-inhibiting activity linked covalently to an oxygenradical generating organic group).

[0036] A further embodiment is the measurement of type I collagenmetabolites, preferably urinary NTx by the OSTEOMARK® Assay (OstexInternational, Inc., Seattle, Wash.), to monitor the increase in boneresorption and hence time the administration of the anti-resorptiveagent for maximum benefit. The NTx analyte is also used to determinethat the bone resorption has been returned to the normal (baseline)range at the end of the therapeutic cycle. A suitable animal model forinvestigating this therapeutic strategy is the guinea pig. RecombinantTRAP is administered by injection, implanted osmotic pump, TRAP genetransfer, or other method. The NTx analyte can be measured in guineapigs because the monoclonal antibody supplied with the OSTEOMARK® Assaycross-reacts equally with human and guinea pig NTx. The dosages of TRAPand anti-resorptive agent (e.g., alendronate sodium or otherbisphosphonate) can be titered and defined based on baseline NTx, TRAPstimulated NTx, and suppressed NTx levels. The benefits in terms ofincreased bone mass can be monitored by dual x-ray absorptiometry (DEXA)or other bone densitometric techniques.

EXAMPLES Materials and Methods

[0037] Tumor-cell conditioned medium: CESJ, Bc66, or Bc-TRAP cells werecultured in serum-free medium. Culture supernatant was concentrated500-fold for CESJ, and 100-fold for Bc66 or Bc-TRAP cell medium.

[0038] Bone marrow colony assays: Bone marrow cells were obtained fromC57Black 6 mice. Mice were housed in the vivarium of University ofWashington, and the animal care and experiments were conducted inaccordance with the institutional guidelines. Bone marrow cells werecultured at 10⁵ cells per ml in culture medium containing 20% (v/v)fetal calf serum, 0.3% agar or 0.25% agarose (agarose was used inexperiments where colonies were harvested for mRNA isolation), andvarious concentrations of test samples. Cell cultures were incubated for14 days at 37° C. in a humidified atmosphere with 5% CO₂ and werestained for TRAP activity after fixation as described (7). Stainedslides were evaluated under the microscope for TRAP positive singlecells, clusters (>8 cells, <50 cells) or colonies (>50 cells) aspreviously defined (7).

[0039] Enrichment of bone marrow progenitor cells: Adherent cells weredepleted from mouse whole bone marrow cells by passing through SephadexG10 columns, and the cells with low density were selected using aPercoll density gradient method. The cells expressing specific lineagemarkers were eliminated by monoclonal antibodies specific for murine Bcells (B220), granulocytes (Gr-1), macrophages (Mac-1) and erythrocytes(YW25.12.7) on MACS (Miltenyi Biotec)using magnetic beads conjugatedwith goat anti-rat IgG, and cells negative for above lineage markers(Lin-) were used as the target cell population of the isolated protein.Colony forming hematopoietic progenitors and osteoclast progenitors havebeen shown to be enriched in the Lin-cell population (Muguruma and Lee,Blood, 91:1272-1279: 1998).

Preliminary Observations

[0040] The bones of mice bearing CE mammary carcinoma exhibit markedlyincreased numbers of osteoclasts with evidence of excessive boneresorption (5). Serum-free culture supernatant of cloned cell lines(CESJ) of this tumor had a unique ability to induce colonies of cellsexhibiting intense TRAP activity in mouse bone marrow cells cultured insemi-solid medium. The activity directly affected progenitors ratherthan being mediated through or in conjunction with accessory cells sinceclonogenic progenitor cells isolated from marrow also responded to CESJmedium and formed TRAP-positive colonies (8). Furthermore, TRAP-positivecolonies induced from isolated progenitors by CESJ medium expressed theosteoclast markers: vitronectin receptor a_(vβ3), ρρ^(c-src) and thecalcitonin receptor, and formed resorption pits during furthercultivation under appropriate culture conditions (8).

[0041] In contrast, the culture supernatant of another mammary carcinomacell line, Bc66 (6,7), did not possess such osteoclast inducing activitydespite containing macrophage colony stimulating factor (M-CSF), and theparent tumor was non-osteolytic in mice. Furthermore, using recombinantmouse M-CSF to induce macrophage colonies under similar assayconditions, the colonies were always negative for TRAP staining even inthe presence of 1,25(OH)₂D₃ (10⁻⁸M) and hydrocortisone (10⁻⁶M) (data notshown).

[0042] In earlier work, one active component was purified from CESJmedium and shown to be an osteoclast colony stimulating factor (O-CSF)(6). During further analysis of the osteoclast stimulating activity ofCESJ medium, it became apparent that another potent factor was presentin the medium that induced TRAP-positive cells to differentiate frombone marrow cells in culture.

Isolation of Osteoclast Differentiating Factor (ODF)

[0043] Over 100 L of serum-free conditioned medium from cultures of aCESJ clone (8) was used to isolate and characterize the factor.Conditioned medium of CESJ cells was fractionated by sequential columnchromatography on heparin-sepharose, hydroxyapatite and molecular-sieveHPLC (Toso Haas TSK gel, G3000 SW). Osteoclast-inducing activity wasmonitored by an assay in which mouse bone marrow cells were cultured for14 days in semi-solid agar (6,7). Colonies, clusters or single cellsderived from osteoclast progenitors were detected by their bright redappearance on staining for TRAP activity.

[0044]FIG. 1 presents results of protein purification of the initialmedium by Heparin-Sepharose column chromatography. Heparin sepharoseCL-6B (Pharmacia Biotech) packed in an Econo-Pac column (Bio-Rad; 1.5×4cm) was equilibrated with 20 mM Tris-HCl containing 0.1M NaCl, pH 7.2.Aliquots of 40 ml of 100× concentrated CESJ medium were equilibratedinto the above buffer and applied to the column for each run. About 95%of the total protein passed through the column as estimated by UVabsorbance at 280 nm. After washing the column with the same bufferovernight, proteins bound to the column were eluted by a linear 0.1-0.7Mof NaCl gradient in 20 mM Tris-HCl (pH 7.2) at a flow rate of 0.7 ml/minat 22° C. A portion of each collected fraction was tested for ODFactivity in the marrow culture assay after re-equilibrating into 20 mMTris-HCI buffer (pH 7.2) and filtering (0.22 μM, Millipore).

[0045]FIG. 1 shows that, on heparin column chromatography, ODF activitywas consistently recovered in the bound fraction eluted at about 0.47 MNaCl. In contrast, M-CSF and granulocyte-CSF (G-CSF), both of which werepresent in the CESJ medium (9) were not bound to heparin. The previouslydescribed O-CSF activity (6) was also not bound. The heparin-bound ODFactivity induced intensely TRAP-positive single cells or clusters of 4to 8 cells in the marrow culture assay, but TRAP-positive colonies ofmore than 50 cells as induced by whole CESJ medium were rather rare.Combining the heparin-bound active fraction and the unbound poolrestored the original TRAP-positive colony stimulating activity of theCESJ medium.

[0046] The ODF activity from the heparin column was bound to thehydroxyapatite column and eluted at about 170 mM phosphate (FIG. 2): Thefractions containing ODF activity from heparin-sepharose were pooled,concentrated and equilibrated by centrifugal filtration through aCentricon membrane into 10 mM sodium phosphate, pH 7.0, and applied to ahydroxyapatite column (Econo-Pac, CHT-11 Cartridge, Bio-Rad). The columnwas washed with 10 mM sodium phosphate, pH 7.0. Bound proteins wereeluted with a linear 10 to 300 mM Na phosphate gradient (pH 7.0).Portions of each fraction were assayed for ODF activity and analyzed forproteins by 14% SDS-PAGE. Material in the fraction which eluted at about170 mM phosphate induced TRAP positive mononuclear cells in the bonemarrow culture assays, but when combined with recombinant murine M-CSFit induced TRAP-positive colony formation.

[0047] Active fractions from several hydroxyapatite column runs werecombined and run on size-exclusion column HPLC (SEC-HPLC) in 0.1Mphosphate buffer (pH 6.8) containing 30% (v/v) acetonitrile (FIG. 3). BySDS-PAGE the ODF activity appeared to coincide with the elution positionof a 35 kDa protein.

[0048] In detail, the active fractions from hydroxyapatite columnchromatography were pooled, concentrated by Centricon ultrafiltration,adjusted to 30% (v/v) acetonitrile and the sample was fractionated bysize exclusion HPLC (two Toso-Haas G3000SW, 7.5 mm×60 cm in series)equilibrated with 0.1M Na phosphate buffer, pH 6.8, containing 30% (v/v)acetonitrile. The eluent was monitored for protein absorbance at 220 nm.Fractions (0.5 ml) were collected into tubes containing 0.02% (w/v)CHAPS (Calbiochem). Samples pooled every 10 fractions were tested forTRAP-positive cell stimulating activity.

Identification of the Osteoclast Differentiating Factor

[0049] Pooled fractions corresponding to the regions of biologicalactivity from another aliquot of the hydroxyapatite pool run identicallyon SEC-HPLC were dried for amino-terminal sequence analysis (Porton2090E equipped with on-line HPLC analysis of phenylthiohydantoin aminoacid derivatives). The only N-terminal sequence evident in fractionsbetween 24-32 ml of elution volume was APTPTLRFVAV which corresponds tothe N-terminus of mouse TRAP, minus its signal peptide (23). In thisregion of column eluent, and in earlier fractions where biologicalactivity was also detected, the 35 kDa protein band was evident. Thesize and sequence were consistent with the TRAP protein (band 5 TRAPisoenzyme; EC 3.1.3.2). No other match or near homology to another genewas found by genomic or protein data-base search.

[0050] TRAP activity was, therefore, measured in a 96-well microtiterplate. Assay for TRAP enzyme activity using p-nitrophenol phosphate assubstrate in the presence of tartrate confirmed the presence of activeenzyme in the various column fractions and in the original CESJ culturemedium. A 100 μl sample (20 μl column fraction+80 μl H₂O) was added to100 μl 0.2M Na acetate, 40 mM Na tartrate, 16 mM p-nitrophenylphosphate, 5 mM dithiothreitol, pH 5.7. After incubating at 37° C. for 1hr, 20 μl 0.5M Na OH was added and absorbance at 405 nm was measured.Column fractions from an SEC-HPLC run were analyzed on SDS-PAGE,staining with silver. Bc66 medium, in contrast, showed no enzymeactivity. The activity was shown to be inhibited by molybdate, a knowninhibitor of TRAP.

Confirming Experiments

[0051] To confirm that TRAP was responsible for the ODF activity, therecombinant enzyme was expressed in two cell lines, Bc66 and Chinesehamster ovary (CHO) cells. Bc66 cells were transduced by a retroviralvector to express rat TRAP (10). Conditioned medium of transduced cells(BcTRAP) demonstrated abundant TRAP enzyme activity and stimulatedintensely TRAP-positive colonies. In contrast, medium of control Bc66cells stimulated only TRAP-negative colonies. Bc66 cells are known toproduce M-CSF. Therefore, CHO cells, which do not produce M-CSF, weretransfected with the vector containing rat TRAP gene (11). Theconditioned medium of transfected CHO cells (CHO-TRAP) stimulatedTRAP-positive colonies while control CHO cell medium did not show anyTRAP inducing or colony stimulating ability. While M-CSF alonestimulated only TRAP-negative colonies, M-CSF and TRAP togetherstimulated large TRAP-positive colonies suggesting a synergism of TRAPand M-CSF in cell proliferation. This discovery suggests that both TRAPand M-CSF might work in conjunction to drive the lineage to osteoclastswith TRAP inducing differentiation and M-CSF proliferation.

[0052] To rule out the possibility that the exogenous TRAP might bedirectly responsible for the observed TRAP-positive staining of thecells in the marrow cultures, TRAP mRNA expression was assessed. Afraction of mouse marrow cells selected on the basis of beinglineage-marker negative (Lin-), and shown to be enriched in osteoclastprogenitors (8) was used. Isolated Lin-cells were cultured in semi-solidmedium in the presence of concentrated conditioned medium from CHO-TRAPor CHO control cells. mRNA isolated at 7 days and 14 days showed theexpression of endogenous TRAP in the TRAP-positive colonies.

[0053] The timing of TRAP addition to bone marrow progenitor assays wasexamined by overlaying the purified TRAP onto agar cultures containingLin-cells and M-CSF at various days of the culture and evaluating thecolonies formed 14 days after the overlays. TRAP-positive colonyformation was observed only when purified TRAP was added during thefirst 48 hours of culture. Addition of TRAP later in the cultureresulted in the growth of macrophage colonies. Taken together, theseexperimental data strongly suggest a critical role for TRAP inosteoclast differentiation. This enzyme seems to act on immatureprogenitors of the monocyte-macrophage pathway and induce osteoclastdifferentiation prior to their commitment to macrophages.

[0054] Transduced BcTRAP cells and Bc66 cells were also subcutaneouslytransplanted into Balb/c nude mice to assess the in vivo effects of aTRAP-producing tumor. Microscopic examination of various tissuesrevealed notable changes only in bone. Morphometric analyses of bonefrom the tumor-bearing mice revealed an increased osteoclastic activityand thinning of long-bone cortical walls in mice transplanted withBcTRAP when compared with mice transplanted with normal Bc66 cells. Theresults essentially reproduced the original findings with CEtumor-bearing mice. TRAP therefore appears to be the critical factorresponsible for the unique osteoclast-inducing properties of the CEmammary tumor cells.

Confirmation of Implant Efficacy In Vivo

[0055] Mouse or human TRAP can be expressed by recombinant means, forexample in Sf9 insect cells from a recombinant baculovirus vectorconstruct (Hayman, A. R. and Cox, T. M. (1994), J. Biol. Chem.269:1294-1300; Ek-Rylander, B. et al. (1997) Biochem. J. 321:305-311).Enzymically active TRAP containing two iron atoms per molecule can bepurified from the culture medium in mg/L quantities. Both phosphataseand oxygen radical generating activities can be demonstratedrespectively by cleavage of p-nitro phenylphosphate or peroxidation ofluminol and chemiluminescence release.

[0056] The ability of TRAP (recombinant or prepared from natural sourcessuch as CESJ-conditioned medium) to promote osteoclast recruitment toimplant surfaces can be assessed in animals in vivo. In one approach, apurified TRAP preparation shown to be enzymically active is dissolved inneutral buffer at low ionic strength. Solid-phase preparations ofhydroxyapatite (or other calcium salt solid phases, e.g., thin layerscoated on biologically inert membranes or free-standing blocks) areimmersed in the TRAP solution to bind or adsorb TRAP molecules to thesurface layer of hydroxyapatite. By cutting and staining sections forTRAP activity histochemically, using azo dye or lead salt methods(Yamamoto, T. and Nagai, H. (1992) J. Bone Miner. Res. 7:1267-1273), thelength of time needed to adsorb a particular thickness and activity ofTRAP can be controlled. Whole preparations can also be stained using asubstrate for TRAP according to prior histological techniques.Appropriately TRAP-coated hydroxyapatite preparations are then implantedsurgically into experimental animals either subcutaneously orintramuscularly. In one example, murine TRAP is used in mice as theexperimental animal. A hydroxyapatite vehicle (hydroxyapatite-coatedmembrane or solid block lacking TRAP) is implanted at an adjacent butseparate site in the same animal to serve as a control. To augment thenumber of osteoclast progenitors in the circulation, experimentalanimals can be primed with factors such as G-CSF that enhance stem cellmobilization from the bone marrow to the bloodstream (Purton, L. E., etal., Blood 87:1802-1808,1996; Matayoshi, A., et al., Proc Natl Acad SciUSA 93:10785-10790, 1996).

[0057] Alternatively, mineralized bone or dentin particles or slices canbe coated with TRAP and implanted similarly, again using uncoatedmaterial as the control for comparison.

[0058] After 7-14 days, animals are sacrificed and the retrievedimplants are examined histologically for osteoclast attachment usingestablished methods. The osteoclast recruiting activity of TRAP-coatedhydroxyapatite surfaces can be thus demonstrated. In a variation of thisapproach, discrete regions of the solid hydroxyapatite surface can beselectively treated with TRAP and after retrieval from the animals,histological examination can confirm an attraction of osteoclastspreferentially to the TRAP-coated surfaces.

[0059] The ability of TRAP to promote osteointegration into or ontometal (or ceramic or other fabricated) implant surfaces as used in jointreplacements or dental prosthetic devices seated into bone can also beinvestigated in animals. Preparations of hydroxyapatite-coated titaniumalloys (rods, plates or other suitably sized fabrications) are coatedwith TRAP and implanted surgically into or onto bone surfaces inexperimental animals. Here, the objective is a longer term evaluation ofthe osteointegration of the bone bed against a plain surface or into aporous surface of a metal implant. Both smooth and porous-coated surfacedesigns are used in metal prostheses, for example the femoral stemcomponent used in total hip replacements. Representative porous metalcoatings for ingrowth of bone include cobalt-chrome powder or beads(Porocoat surface, DePuy; PCA, Howmedica) and the diffusion bonding oftitanium wire mesh (Zimmer). Such porous metal surfaces are preferablyfirst coated with hydroxyapatite by plasma-spraying techniques, beforecoating with TRAP. Osteointegration is judged in individual animals attime intervals of 1-12 months after surgery by x-ray imaging to evaluatedegree of radiolucency, and hence gap between metal and bone, and byretrieval, sectioning and microscopy of the metal/bone interface of theimplant. Such methods are commonly in use by implant manufacturers toevaluate new materials, fabrications and other aspects of prostheticdesign. In this way, the advantages of TRAP-coated surfaces forpromoting osteointegration is established and the coating protocoloptimized for different clinical applications.

[0060] It is further contemplated that other biological materials can beincluded with TRAP in the mineral-phase substratum to promote boneattachment. Representative biological materials for this purpose includecytokines or other signaling molecules and collagen, the latter toenhance mechanical coupling of the new bone matrix to the implantedcomposition or device.

[0061] While the invention has been described in conjunction withpreferred embodiments, one of ordinary skill after reading the foregoingspecification will be able to effect various changes, substitutions ofequivalents, and alterations to the subject matter set forth herein.Hence, the invention can be practiced in ways other than thosespecifically described herein. It is therefore intended that theprotection granted by Letters Patent hereon be limited only by theappended claims and equivalents thereof.

CITATIONS

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[0071] 10. Palmer, T. D., et al., Proc. Natl. Acad. Sci. USA84:1055-1059, 1987.

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[0085] The entire disclosures of the prior publications and patentscited in this patent application are incorporated by reference herein.

The embodiments of the invention in which an exclusive property orprivilege is claimed are defined as follows:
 1. A composition suitablefor medical implantation comprising tartrate-resistant acid phosphatase(TRAP) adsorbed to a porous hydroxyapatite substratum.
 2. A bone graftcomposition according to claim 1 .
 3. The bone graft composition ofclaim 2 , wherein the hydroxyapatite substratum is selected from amongautologous bone, cadaveric allograft bone, and coralline hydroxyapatite.4. The bone graft composition of claim 2 , wherein the TRAP is adsorbedthroughout the porous hydroxyapatite substratum.
 5. The bone graftcomposition of claim 2 , wherein the TRAP is adsorbed to only the outersurface of the porous hydroxyapatite substratum.
 6. A bone cementcomposition according to claim 1 , comprising tartrate-resistant acidphosphatase (TRAP) adsorbed to a particulate hydroxyapatite substratumadmixed in a curable acrylic polymer.
 7. A prosthetic device having anouter bone attachment surface comprising tartrate-resistant acidphosphatase (TRAP) adsorbed to a hydroxyapatite substratum.
 8. Theprosthetic device of claim 5 , wherein the TRAP is adsorbed to the outerapproximately 10 microns of the hydroxyapatite substratum.
 9. Theprosthetic device of claim 5 , selected from among an artificial jointand an artificial tooth.
 10. An orthopedic attachment device having abone contacting surface comprising tartrate-resistant acid phosphatase(TRAP) adsorbed to a porous hydroxyapatite substratum.
 11. Theorthopedic attachment device of claim 10 , selected from among a screw,a staple, a pin, a bolt, and a plate.